Replace at a later date. A few things about that. Republicans will, one, likely need 60 votes to wholesale repeal the aca. Thats ten more votes than the 50 votes they havent been able to get for their proposed bill. Two, just repealing the aca would leave 33 million million more people uninsured than under the current law. Thats even worse than the Senate Version of trumpcare, which would leave 22 million more uninsured. Three, re pealing obamacare without having a replacement ready would likely further destabilize the Insurance Markets and lead to even more insurers pulling out of the exchanges. And four, who actually believes republicans would ever get around to the replace part . Joining me now republican strategist christopher metzler, Jonathan Cone of the huffington post, and tommy binion, director of congressional relations for the heritage foundation. Im going to start with you, tommy, and dispense with this idea of just repealing altogether obamacare because that would send the entire market into chaos, right . I dont think so. I think the markets would respond the way we expect a free market to respond. We know that free markets bring competition between firms when theyre competing for your business, theyre going to offer a better product at a lower price. Part of the reasons premiums have gone up so high is because of obamacare. I expect premiums to get a lot cheaper if obamacare were to be repealed. I think what were seeing from the president with that tweet, with his statement that if repeal and replace doesnt happen, hes still committed to keeping his campaign promise. President trump is absolutely committed to keeping that promise and all of his campaign promises. But no, i dont think that we should expect the Insurance Markets to collapse. Really . If republicans do what they say theyre going to do. If there was a robust market to insure the people who were added to the insurance rolls under the medicaid expansion, these are basically the working poor, people at 125 of the poverty rate, if there was such a robust market to offer them insurance then why wasnt it there before obamacare . Well, if were speaking about those people on medicaid we are. The cbo assumes some would leave medicaid, but medicaid is free. What . Theyre required to be on it under obamacare. And the cbo assumes some of them would leave despite not leave, no, no. Lose im sorry. They would not leave. This is not people voluntarily saying, you know, i choose to go uninsured. Its people losing their Health Insurance, essentially not having Health Insurance anymore. I want to get into under the senate bill nobody under the senate bill 22 Million People would lose their Health Insurance. The bulk would be because of cuts to medicaid. I want to go specifically into it because i want to make sure people really understand it because there are two different buckets of insured. There are about 10 Million People who buy in the nongroup market. Thats who you and the republicans are legislating for, just them. The 10 Million People who buy insurance under obamacare. So if we talk about those people, the new bill that they are the republicans are proposing would essentially force this is a great piece that the nbc news did a great analysis of this and it essentially said the bill would require people to pay higher premiums this is the nongroup people, to buy a private plan thats similar to whats already under obamacare. So theyd have to pay higher premiums to get what they get under obamacare now. And then it would reduce spending on the subsidies and distribute them in a way that encourages people to instead purchase a high deductible plan with lower premiums. People with lower premiums are just stuck with a high deductible plan. You think thats better . No, not in that specific case. That is for the nongroup market. Thats what would happen. Well, the cbo said late this week that this bill would actually drive the cost of premiums down by about 30 . For people who are getting right, they would drive the cost of premiums down for people who were then pushed into high deductible plans. You pay a lower premium, but when it comes time to use your insurance, youre paying a much higher deductible. Thats exactly what the cbo said. What those people will have under the senate bill is more choice. We know when they have more choices theyre going to exercise that choice. Thats a great bumper sticker. Thats a great bumper sticker. Because remember were still only talking about nongroup market but thats true. Hold on. Youre basically saying if people can buy more junk insurance, insurance that really doesnt cover much, insurance that has low premiums but insurance that covers the things they want. That are basic things. And most people like the services that theyre getting under obamacare, the free mammograms, et cetera i think most people want to pick the services they get, not have the federal government would they also pick to be uninsured . Because you keep on saying that people would voluntarily disenroll from insurance. And theres no would you voluntarily disenroll from insurance . I didnt say that. The cbo said it. No, the cbo said they would lose insurance. Said very specifically they would lose insurance. They said a few million would voluntarily leave lose their insurance. And the only people who would voluntarily disenroll and the only people who actually again get lower premiums are people who dont want to pay the penalty under obamacare and therefore disenroll because they didnt want to buy insurance. Thats a tiny fraction of the American People. Of that 10 million youre talking about maybe a couple of Million People. And then it also says at the same time that when you take away the subsidies from people lowincome seniors would be hurt the most. Sfwlt subsidies under the senate bill hold on. The biggest spikes in uninsurance, and im just saying what the cbo said, the biggest spikes in uninsurance come from older lowincome customers who would also have the hardest time finding affordable insurance. What do you think . Look, if were talking about the cbo, lets just think about how they did predicting no, no, answer my question. We dont have time to talk about the cbos methods. Do you think its a valuable tradeoff to have lower income people, the oldest and lowest income people have the hardest time finding insurance and be the most likely, the biggest spikes in losing their insurance . Do you think thats a fair tradeoff . I dont think thats what will happen under the senate bill. Thats what the cbo says will happen. I dont believe them. Lets go to Jonathan Cone why shouldnt they . Because they were spoton in the number of people who would get insurance. They had a different mix no, they werent spoton. They were incredibly wrong about it. They were wrong about how much it would cost and who would be insured. They were not. Health costs have gone down and number of people overall have gotten insurance correct. The mix of people who got it in the nongroup market versus the 72 million on the medicaid, the mix is what they got wrong. I want to get jonathan chone in here. Because the thing we know about this idea that is floating through the senate, and this is aside from them saying well repeal the whole thing. Is theres a one for one tradeoff taking place here. Approximately 700 million in tax cuts that go overwhelmingly to not just the top 1 but the top 0. 1 , so 700 billion in tax cuts for them. For 700 billion in cuts to medicaid. And that is the equivalent, essentially, of having the top 400 richest households in america, okay, the top 400 richest people in america, their tax cut is the equivalent to medicaid for arkansas, alaska, West Virginia and nevada combined. Is that a fair tradeoff in any way in your mind, mr. Cohen . So, i mean, look, whether its a fair tradeoff, thats a value judgment, right . Some people would say its fair, some people would say its not. But i think thats exactly the right way to think about this. And you know, we talk about health care, theres so many moving pieces. You were just talking with your guest about the mandate and the effects of the subsidies and where it all and theres some dispute over where you know, how this piece affects that piece and how many people are voluntarily dropping coverage or whatever. But the key thing to remember to pan out just like you did to say, look, this is taking a trillion dollars away from programs that help people pay their medical bills. Its coming out of medicaid. Its coming out of subsidies to help people buy private insurance. If you take that much money out of federal health care programs, a trillion dollars over ten years, one way or another you are telling millions of people they are not going to be able to pay their medical bills. Its just a reality. That is what we are looking at with this bill. And that is why this bill is so hard to pass because every time you look at it they tinker with the pieces, they move a little money here, they move a little money there, but at the end of the day there are millions of people who wont have Health Insurance, there are millions oof people who will have Health Insurance but will have even higher deductibles than today. You know, obamacares not perfect. Everybody admits that. It needs improvement in a lot of areas. But relative to what we have today, pass the senate bill, pass the house bill, you will have substantially more americans, in the millions, who will be struggling relative to today. Mr. Binion. Its faulty logic to say every dollar the federal government spends on Health Insurance is the only dollar that could help people. We know from 200 years of American History that the free market and Free Enterprise delivers the best products. Why would we take that out of the Health Care Market . Youre giving us theoreticals when were telling you if you take the absolute dollars that you spend to cover people with medicaid, to give People Insurance cards and you reduce that by a trillion, that if you i mean, in absolute dollars that means fewer people can be helped by the program. If you repeal the medicaid expansion, everyone who was added to medicaid because of the expansion comes off medicaid because the expansion isnt there. The theoreticals about the free market dont give People Health care. I want to come to it doesnt give People Health care for you to talk about the free market. Talk about the free market makes you feel good. It doesnt give people a medical card. The government wont solve all of our problems. Then why werent those people insured why werent those people insured under the free market before obamacare . More people will be insured if Health Insurance why werent those people insured under the free market system we had before obamacare . Many of them could have been and chose not to. They werent insured until the government forced them to be. Then were did they sign up . Youre saying people wouldnt have wanted the medicaid they wouldnt have taken med sxaid had an insurance card to go to the doctor if they it ends the expansion. No, it doesnt. No it does not. Okay. Thats actually not true. Lets come to Chris Metzler. Because what were doing i love talking with ali velshi about this. I wish he was here but hes having a life. And what he i think pointed out this week which was so important and i think so fundamental to this debate were having politically is that when we talk about health care we tend to lump everything in together. There really are two Health Care Markets. Theres the nongroup the three, the nongroup market. People who buy their own insurance, Small Business people, people who really a lot of times ive met dont like obamacare because for them some of their costs have gone up. In some regions, we have a map shows in a few regions i think 38 counties theres only one insurer. So in some cases nongroup people have suffered. That needs to be fixed. Thats about 10 Million People. Then youve got the bulk of americans who get their insurance the way i do, through your employer. Yeah. And they only benefitted from obamacare through important things like free mammograms, services they were able to get, keeping your kids on which my kids are still on my insurance. And then youve got this third group of about 72 Million People who are on medicaid. They are sort of the big elephant in the room because if you hurt them its such a much bigger market. Why dont republicans ever legislate for that group . Why is that group always getting punitive measures and that 10 million always getting catered to . Well, i think your analysis is absolutely right. If youre talking about im the ceo of a health care firm. And so for me the senate bill just simply does not address those issues. Im a free market guy. I believe in free markets. However, the discussion at this point is in fact very theoretical. When i see people walking into my urgent care who cannot afford insurance, thats the concern. As a Small Business we are also looking at reimbursements. The reimbursements simply are not high enough. For medicaid. For medicaid. Theyre not high enough. So i think if part of the reason this bill has not passed, this bill is not ready to go anywhere. Yeah. At this point. So you are because you are a republican. Yes. A Small Business owner and a free marketer, a free marketeer. Tell mr. Binion if you could because he has a theoretical idea about what would happen if you undid obamacare and youre living it in the real World Running a health care company. Yeah. In your view if you repealed obamacare in total what would happen . If you repealed obamacare in total, essentially what will happen, remember the auto bailouts, remember all of those kinds of things . Yeah. If you take it just completely off the table, then were going to end up having to bail out hospitals, emergency rooms, because thats where people are going to end up. Right. And so thats a part of the discussion. The debate within republican circles is you have the folks who are essentially saying you havent gone far enough with this bill. Right. Then you also have some conversation around, well, you know, we need to Work Together to get this done. So from my perspective, if in fact you were simply to take it off the table, youre going to have a lot of people. And from a straight political standpoint a lot of those people are going to be the president s supporters, the president s base. Yeah. Thats whats going to happen. I live this every day. So i cant have a theoretical conversation about this because i live this every day. Mr. Binion. Every american lives this every day. And what their personal experience with obamacare has been is that the cost of their Health Insurance premiums have gone up. You cannot speak for every american when you say that. Thats a blanket statement about the people that you know and you talk to. I just have somebody sitting here at the table whos in the health care business. Dont speak for all americans about whats happened. There are theres data that shows whats happened to costs. That its gone up. Insurance always goes up. Insurance premiums go up. Hello. Its what they do every year. Jonathan cohn, im going to give you the last word. Have you ever known a year in American History in your adult life when insurance premiums on an annual basis have gone down . No. I mean, look, there are winners and the cbo says this bill will make them go down. Maybe next year. No. For people that buy high deductible plans, the small tiny slice of the public who you only see. You dont see anyone else. The rest of the people are invisible to you because youre thinking about that wealthy affluent Business Owner who doesnt want to buy insurance for their employees. And yeah, maybe they hate obamacare. But what about everyone else . Im sorry. I was trying to give Jonathan Cohn the last word. Go ahead, jonathan. I was going to say there are winners and losers in all of these policies. There are certainly people under obamacare paying more, there are a lot of people paying less. And the key is what you said if you go to the senate bill, look what happens, the true premiums eventually come down but that is because the insurance covers less. If i told you i was going to trade your cadillac in for a bicycle, youd save money by, you know, paying for the bicycle, but that doesnt mean youve gotten a better product for going around. I have gone way over time, so im going to stop. Christopher mettsler will be back. Jonathan cohn and tommy binion, thank you for the spirited debate. Appreciate it. 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